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Tuesday, November 21, 2017

Mother, Mother. . .

Student At University Studying And Getting Educated: Hi. I was wondering if my prescription was ready?
CP: Not yet. We did receive it but we have not finished it. Give me 20 minutes and we shall have it ready for you.
SAUSAGE: Many thanks. I will be there then.
 <5 minutes later>
SAUSAGE's Mom: I was calling to see if my little SAUSAGE's medication was ready.
CP: Well, I just spoke with your little SAUSAGE and explained that 20 minutes was all I needed to complete the filling process.
SAUSAGE's Mom: Okay. I'm just trying to make sure it's taken care of. My little SAUSAGE goes to university out your way.
CP: I know. I heard.
<5 minutes later>
Store Local To SAUSAGE's Mom: I'm not sure why, but I'm calling to see why you're having trouble filling a prescription for a student of ours.
CP: Let me guess. You got a call from SAUSAGE's Mom?
CP: <recounts how we spoke with both SAUSAGE AND SAUSAGE's mom> So why did she call you.
SLTSM: Not sure. But this is for a student? An adult student? A university student?
CP: Yes.
SLTSM: What is going on with parents today?
CP: This has me wondering who is going to chew up the medication for SAUSAGE and spit it into SAUSAGE's mouth like a mama bird. Not sure how SAUSAGE is going to be able to manage to coordinate the drinking of water and swallowing a whole tablet at the same time.
<other line rings>
Uber-Tech: Yes, ma'am. We are speaking with the other pharmacy right now. Yes. We are filling it right now. No. I am not sure what the problem is, <whispers> other than you.
CP: Again?
UT: Yes.
CP: What now?
UT: Just making sure everything is being taken care of for her little SAUSAGE.
CP: No wonder this kid flew so far from the nest to go to school.

"Hush now, baby, baby, don't you cry.
Mama's gonna make all of your nightmares come true.
Mama's gonna put all of her fears into you.
Mama's gonna keep you right here under her wing.
She won't let you fly, but she might let you sing.
Mama's gonna keep baby cozy and warm."


Just Because You Can . . .

I do not let people bully me. That's what it is, bullying.
People believe they can get away with anything when it comes to retail transactions. Partly it's due to our disconnected society. We don't have to interact with people face-to-face to complete most of today's transactions. We order everything online from Amazon. We receive automated reminders from the pharmacy, the dentist, the doctor. We receive tonight's dinner, ready to cook, from Blue Apron or Sun Basket. We text each other. We email. We stare at our phones while sharing dinner together. 
When we are called upon to actually converse and have a tete-a-tete, we don't know how to interact and exhibit socially agreeable behaviour. 

If a patient becomes confrontational, I shall intervene. I have no problem inviting them to never return. Go sell crazy some place else. 
It sounds as if this is not going to be phunny, but I love turning things around on my boss. 
I love looking at things from a standing-on-my-head perspective. 

CP's Boss (Her Royal Highness): I see you gathered another complaint. 
CP: <Proudly Puffs Out Chest> I did. I'm on a roll. 
HRH: You're not supposed to be collecting them. 
CP: Why not? Some people collect penguins. Some collect Star Wars memorabilia. I prefer to dabble in chaos. Complaints are my phriends. 
HRH: How so? They are a negative reflection on your attitude. 
CP: <whispers> Says the boss who doesn't deal with the public. 
HRH: What's that? 
CP: Nothing. Just admiring your dedication to keeping me on the straight-and-narrow even though you couldn't do my job which is why you got promoted. 
HRH: Just because you can do, or in this case, say something, doesn't mean you should. 
CP: Why not? People are too easily offended. Your perfume offends me. Your garish hairstyle offends me. Patients who yell and scream and throw temper tantrums like 2 year olds offend me. Unfortunately, I have to deal with all of them today on top of making sure I meet your quotas and that little professional expectation of not killing people. 
HRH: Complaints are not healthy. 
CP: Wrong. You have to know how to read them. Like news and studies on the internet or in journals, you have to know HOW to read and interpret them. They are not all the same. You paint me with a broad brush and believe I am a bitch based solely on my complaints. I will not allow any patient or boss or visitor to my store to belittle me or my staff. Period. I will stand up for everyone here. I do not have to take abuse. If I wanted that, I'd sign back up for that S&M class I dropped out of right after college. 
HRH: Um. . . This is why I only visit here for short periods of time on a rather infrequent basis. 
CP: Anything else before you shake babies and kiss hands and play your exit song on the way out the door? 
HRH: Cuts in hours will be coming soon. We will also reduce your overlap by half so be prepared to do more work with less help. 
CP: I'm thinking "no" on that one. 
HRH: <head swivels around violently, cracking> What did you say? 
CP: I. Said. No. To quote a phairly self-phamous person, "Just because I CAN does not mean I should". So, no. I will not be doing extra work just because you think I can.
HRH: How do you still have a job?
CP: Because people love me. I get everything done, despite your greatest efforts to thwart me, and I still do it all with a cryptic smile on my face.
HRH: Yeah. It's creepy. I've never been able to figure out how you do that.
CP: Practice. And despite the cynical attitude I have towards the profession, I love what I do. 

Friday, November 3, 2017

Opioid Epidemic Hurts Everyone

In The War On Opioids That Amasses No Gains (WOO TANG for short) another innocent victim has been discovered. Companies are quick to promote themselves as leaders in the WOO TANG.
CVS Caremark announced how they are limiting supplies through the pharmacies.
States have limited quantities that may be prescribed.
Insurances are blocking anything more than a 7 days supply for a prior auth.
These are all great steps. 
However, as with all great strides, a few missteps must occur. 
Unfortunately, the innocent suffer. 

Uber-Tech: I need your brain.
CP: Trust me, you don't want it.
UT: I need its view of this.
CP: It will be skewed.
UT: Look at this reject for this child.
CP: "Max of 4/day". Got it. What are the directions?
UT: Take 4ml by mouth every 6 hours as needed for pain.
CP: Well, that is 4 doses per day. I'm confused why there is a limit. Let's call.
UT: On it.

CLueless Insurance Talker: How may I (not) help you today?
UT: What?
CLIT: Nothing. Go ahead and start getting phrustrated. This will not end well for you.
UT: I'm trying to figure out why this claim will not go through. I tried rounding up in case the insurance didn't like the days supply but I still get a reject.
CLIT: I see all of your valiant attempts. You probably haven't been this rejected since high school.
UT: What's the magic number I need to submit to get a paid claim?
CLIT: <drags out a long> Fooooouuuuurrrrrr.
UT: For what?
CLIT: Just 4. As in "per day".
UT: Speak English.
CLIT: The insurance allows a maximum of four(4) ml per day. Period.
UT: Units would've helped there. There is a big difference between 4 ml, 4 doses, and 4 days.
CLIT: Ahem. And now phor my prepared statement: "Due to new opioid limits, the insurance restricts this medication to a total of 4 ml per day. Should the patient require an amount to exceed the total of 4 ml per day, the patient must contact his/her insurance directly to begin the process of a prior authorisation."
UT: Wait. What?
<UT repeats phor CP>
CP: Wait. WTF? Dosing of 4 ml 4 times a day is normal. He does realise this is NOT an opioid, correct?
UT: You do realise this is not an opioid, oui?
CLIT: It is part of the insurance's ongoing battle against the evil scourge, the plague of opioid addiction blanketing communities across this great land of ours.
CP: It's phor a child.
UT: It's phor a child.
CLIT: We have to stop them early. Before they become addicted or these medications reach the hands of innocents for whom they were not intended.
CP: Can we request an override? Begin the prior auth ourselves?
CLIT: No. Only the patient can begin the process by calling her own insurance. They will then contact the prescriber for an override.
UT: This is rather complicated phor a little pediatric patient to deal with on a Phriday night at 5pm. By the time they would have completed the medication, the prior auth would not have started.
CLIT: Not my problem. These are the rules. Get used to them. I'm sure we insurance companies and PBMs will come up with even more mind numbingly phrustrating blocks to patient care under the guise of "helping" in the near phuture. <click>

UT: What now?
CP: Now that everyone is on the hook, let's tell them the medication.
UT: So they can get really pissed?
CP: So they can see the extent to which we went phor this poor little guy to get his prescription philled on his insurance. Never mind it cost less than $5.00. I just had to know why, no HOW the insurance blocked him phrom receiving his post-surgical pain medication under the "Opioid" banner.
UT: It really is ridiculous, nay ludicrous that we had to spend so much time to get an answer. It wasn't about getting reimbursed. It wasn't about the patient not being able to pay. It's the principle. This was the first time we had seen this rejection and it made absolutely no sense.
CP: Seriously. How in the world could an insurance company lump IBUPROFEN 100mg/5ml Suspension in with an Opioid rejection? It's not possible. It had to be an error. There had to be an override for a post-op prescription for a child. This is sold OTC. You don't need a prescription.
UT: We cashed it out, gave them a syringe, explained how their insurance sucked, and wished him a speedy recovery.
CP: Before you ask, this all happened well within the promised wait time, while we were accomplishing a multitude of other tasks so we didn't actually waste time on it. However, now you don't need to call on this rejection because we did it phor you.
UT: You're welcome.
CP: I hate insurances.

Tuesday, October 31, 2017

Who? Me?

In #Pharmacy, it would be helpful if everyone would remember the phollowing mantra: "It's not me. It's you."
We didn't receive the e-script you sent? It's not me. It's you.
You are out of refills and I faxed your prescriber but he didn't respond yet and now you want to know what to do? It's not me, it's you.
Or, as phar as the blame game goes, let's try this one:

CP: Welcome to CP's 10 minute oil change. How may I help you?
Dad Overreacting Here: Oil? Change?
CP: I'm trying out new names. It's better than 10-minute Stick and Prick which is ultimately what we've become during October as it's Phlu Shot Season.
DOH: Got it. How long will it take to fill my child's prescription?
CP: Barring any unforeseen issues with your insurance or a Tusken Raider party marching through, I'd say about 15 minutes right now.
DOH: Ok. I'll wait.

<walks out to waiting area where DOH is checking his BP>
CP: Did you pass?
DOH: I have blood pressure.
CP: Good. Unfortunately, your insurance requires a prior authorisation on this medication.
DOH: What's that mean?
CP: The insurance won't pay for it. While I realise your son has taken this before, he switched medications from last month so the insurance needs the doctor to call before they will approve it.
DOH: "You mean my kid's gotta go without it?"
CP: No. I said your "insurance won't pay for it". See, I even quoted myself from the last line. However, you are welcome to pay for it yourself.
DOH: How much is it?
CP: Just shy of $200.00.
DOH: "What?! I'm not paying for it."
CP: Oh. So you mean your kid's gotta go without it? (See what I did there?)
DOH: Er. . .
CP: Wow. You were all too happy to blame me for keeping your child unmedicated. Now I get to blame you. Phunny how things work when you don't listen and just react. You have plenty of options to ensure your "kid doesn't gotta go without it" but "Insurance paying for it today" is the only one off the table.
DOH: I guess he can't go trick-or-treating tonight since all the candy will make him hyper.
CP: That's a fallacy. Besides, you could just, you know, restrict what he's allowed to eat.
DOH: Thanks for ruining his #Halloween.
CP: You're welcome. May I verify your address before you storm out, pouting like you proclaim your son will?
DOH: Why?
CP: I need to tell them where to send the "Dad Of The Year" Award.

Thursday, October 26, 2017

On Time Is Early and Late Is On Time

In some countries it is considered rude to arrive early to a dinner invite. 
It is also considered rude to bring wine. Glad the wine thing's not customary round these parts. 

If I tell you a time, I expect you to be there at that time. While arriving a few minutes early for a job interview or date is acceptable, two hours is a little overeager. 

CP: How may I help you today and frustrate myself tomorrow? 
Lady In Waiting: I need to have this prescription refilled. 
CP: I see. Unfortunately we are currently out of this product. It is a special order item. We used it all today. There was a run on it. It's been on backorder. I don't carry it because their labels clash with my pharmacy decorations. Pick one. 
LIW: This happens every month. 
CP: Perhaps you should listen to me and plan ahead. Maybe call in a day or three ahead as I've asked, begged, implored? 
LIW: Phine. When should I arrive tomorrow? 
CP: You should arrive at 3pm. And the hour of the arrival shall be 3pm. No earlier. Thou shalt not arrive at 2pm unless thou shalt sit in thy car until 3pm. 1pm is right out. 
LIW: Until tomorrow then. 
CP: Until tomorrow. . .

<Tomorrow. Noon.>

CP: So much for me believing we had cleared up your pickup time. 
LIW: You did not expressly rule out anything before 1pm. 
CP: Make yourself comfortable. You've got 3 hours to kill. 
LIW: Why can't I get it now? 
CP: Because it's not ready now. When you head to your phamily's house for Thanksgiving dinner, do you eat before or after the turkey is done cooking? Do you just tell everyone "well, I'm here so it's time to eat" even though the bird has 3 more hours to go? You can arrive at the airport (an hour or two is always good practise), the theatre for a play, a concert, a movie, etc as early as you want, maybe even 3 hours like you are today. However, that does not mean your flight will leave or the show will start simply due to your presence. "Oh, I didn't know LIW had arrived. Let's get this party started. Flight schedules and movie times be damned!"
LIW: How much longer? 
CP: How long did that harangue take? 
LIW: You have a weird way of explaining things. 
CP: It's logical, methodical, and shows how people apply rules differently based on the situation in which they are present. I prefer to apply them similarly or at least as dictated by decorum. 
LIW: Is it ready now? 
CP: Is it 3pm now? 
LIW: No. 
CP: Thanks for answering your own question. 
LIW: I'll be back at 3. 
CP: Pleasure doing business with you. 
LIW: The pleasure was all yours. 
CP: It always is.

Monday, October 23, 2017

Why Your Pharmacist Is Phrustrated

Did you ever wonder what goes on in the restaurant's kitchen while you're enjoying the atmosphere and a bottle of Malbec in the dining room?
I'm sure lots of things happen we don't know about.
Perhaps they overcooked the steak.
Perhaps the risotto is phucking runny.
All that we, the diners, see is a beautiful meal that tastes good and doesn't kill us.
Unlike pharmacy, in a restaurant there is not a third party between you and the chef to phuck with your order.
Imagine someone grabbing the tickets phrom the wait staff then altering them based on their own made up "guidelines" before handing it off to the chefs phor preparation.

(Remove the "Oscar" phrom her steak. We're not paying for that up charge and she doesn't need the calories.)
(She needs a prior authorisation phor the Filet. She can start with sirloin or a T-Bone but that's it.)
(No calamari appetizer. Eat a salad.)

Then when you phinally receive your meal, it barely resembles your original order.
This is how the pharmacy does work.
We receive your order, enter it into the computer, cross our phingers that no one phucks with it and it gets stuck in the Reject Wasteland, then deliver it to your table, er hand.

Here is what went on behind the scenes last week at my pharmacy phor one patient:
(I'll phast phorward to the part AFTER I called the CNP to correct her on the dosing of this particular medication.)

Uber-Tech: What's up?
CP: Twenty-five years and my life is still, trying to get up that great big hill of hope, for a destination.
UT: Really?
CP: Sorry. You led me to it and it phelt apropos of the situation.  Just another in a long line of phrustrating rejections.
UT: Do go on.
CP: I have to call this insurance company for the dumbest reason ever.
UT: What's that?
CP: The prescriber wrote for "Zithromax 500mg tablets. Take all 4 tablets by mouth together as a single dose."
UT: Typical.
CP: Right? It's the normal, FDA-approved dosing for Gonococcal urethritis and cervicitis.
UT: I'll call phor you.
CP: Thanks.

<10 minutes later>

CP: Well?
UT: <ahem> "The insurance limits the dispensing of Azithromycin 500mg tablets to 3 tablets in a 30-day period." and before you ask, they also limit the 250mg tablets to 6 tabs dispensed in the same period so no, we cannot do what you're thinking.
CP: But it is a legitimate, FDA indication. A single, 2 Gram dose.
UT: They said you could request a prior auth.
CP: Right. I'm sure the practitioner wants to start that tonight since she already went home, it being 4:15pm on a Friday night. So the patient can pay out of pocket for a single tablet or wait until Monday in the hopes that her prescriber will begin the P/A process AND that her insurance will cover it.
UT: Pretty much.
CP: Too bad insurances weren't such assholes about paying phor opioid prescriptions. I guess they're not receiving kickbacks phrom the manufacturers on antibiotics.
UT: What are we going to do phor her?
CP: Same thing we do every night, Pinky. Take care of the patient and tell her her insurance sucks. I'm not above explaining #WhyYourPrescriptionTakesSoLong and rightly blaming the meddling middleman.
UT: Bill the 3 tabs on the insurance and then 1 tab as cash?
CP: You got it.
UT: Want to go phor sushi and saki after work?
CP: That is disturbing. And, yes.

Friday, October 20, 2017

Listen, Acknowledge, Understand, Deliberate, Agree, Naturally Utilise My Expertise

I can read it to you.
I can write it and spell it out phor you.
I can do an interpretive dance phor you.
I can use hand gestures (I mean, signals).
However, I cannot understand it phor you.

CP: Hey partner.
CPP: Howdy Pardner.
CP: Easy Cowboy.
CPP: Sorry.
CP: I understand. You're the only one back here with a country station on your Pandora.
CPP: It's only a couple songs. Honest.
CP: Phine. Here's your task phor the day. Look at this e-script I received over the weekend and call the prescriber.
CPP: Shore thang!
CP: <partner's gonna kill me for this dialogue> What are your thoughts?
CPP: Do they make this?
CP: Not that I am aware.
CPP: I see it. But I've never seen it. Were they just playing a pharmacy version of Cards Against Humanity? I'll take a drug name, a strength, and a dosage phorm and make a Franken-Drug on my e-script software. How does something like this even get through?
CP: As I've said before, they didn't ask us to design the software. But that's another post.
CPP: Did the patient come in phor this over the weekend?
CP: Certainly did.
CPP: What did you say?
CP: This product is not available as written. I realise this is phor your young child but I have no way to dispense you anything close to what is written here. I shall ring your office('s neck) on Monday and ask phor an alternative.
CPP: Sounds phair. Let me call.
CP: Well?
CPP: Had to leave a message. It went something like this. <Ahem> "Dearly beloved, we are gathered here today to get through this thing called life. I believe we can get by with a little help phrom our phriends at your office. The prescription you sent to us over the weekend for Sweet Child O'Mine is commercially unavailable. You shall either have to alter the strength, the dosage phorm, or the medication itself. Please call us and we may review the alternatives you choose to ensure we can get them if we do not have them in stock. Again, please call us with an alternative. Sincerely, The Revolution."
CP: Nice, professional, direct, to the point, yet simple and classy.
CPP: Thanks.
CP: I'm betting on voicemail as their return call.
CPP: Damn. You always guess voicemail.

<4 hours later>
CP: You need to listen to the voicemail.
CPP: Herr Dr. Zoffis?
CP: Jawohl.
CPP: <reciting the message> "The prescriber would like to cancel the prescription sent over the weekend. Since you cannot locate it, we will call the patient and instruct them to purchase it over the counter."
CP: Um. . .
CPP: Perhaps my message was TOO simple?
CP: No. It's not you. "If the instructions are not clear, if the orders are not obeyed, it is the fault of the general. But if the instructions ARE clear and the soldiers still do not obey, it is the fault of their officers."
CPP: You are wise beyond your years.
CP: Nope. Just recognizing that when the patient's mom returns, she will ask us to phind the product her prescriber told her was available OTC.
CPP: Ah yes. The Circle of Pharm Life.
CP: I wonder if anybody ever counts my references. This post is ridiculous.

Another reason #WhyYourPrescriptionTakesSoLong and #WhyYouShouldntAlwaysTrustYourPrescriber

Friday, October 6, 2017

Real Conversations With Real People

Sometimes it falls upon your phriendly pharmacy staff to phone your insurance company. It is a necessary evil but one which we shall undertake to provide superior customer service. . . or at least get you your refill since Mail Order is the Devil Incarnate and . . . but I digress.
Now, phor your reading pleasure, I present. . . Tales Phrom The Pharm Side.

Uber-Tech: CP, we have a problem,
CP: Go phor CP.
UT: Apparently, Ms. Golightly's prescription is too soon.
CP: Dear Holly? How dreadful. I shall call for an override.
UT: That's why you're the best. Always looking out phor the little guy.
CP: I haven't even had Breakfast yet.
<pluckily dials insurance>
Practically Below Microbes: Thanks for calling Rejections R Us. How may I thwart your efforts and phrustrate you today?
CP: If only everyone was so honest.
PBM: Huh?
CP: Nothing. I was calling to get a mail order override for a lovely patient on her brand new medication that was processed by mail order today and not received yet from mail order since it was processed today by mail order.
PBM: Okay. And you are trying to bill it for what date?
CP: Today. 10/1/17.
PBM: Okay. I see that the patient's mail order processed a claim for a 90 days supply on 10/1/17.
CP: Correct. I can't quite figure out how they can bill a claim immediately but take 3 weeks to ship it to the patient. Baffling. Any who. . . I'd like an override so the patient may receive medication phrom me to begin therapy today.
PBM: Okay. Is the patient low or out of medication?
CP: As I stated earlier, before your teleprompter kicked in to gear, this is a new medication, so she can be neither low nor out since she never had any.
PBM: "We can only do an override if the patient has not received her mail order yet."
CP: Are you listening to yourself? Do you understand the words that are coming out of your mouth? I told you this was a new medication. Today. YOU told ME that mail order processed the claim . . . TODAY. Now how in the 7 layers of Pharmacy Hell can the patient have sent a prescription to mail order, had it filled, taken all of it, been out of it, and received a new prescription for me to fill all within nanoseconds? It bends the time-space continuum.
PBM: I have to enter a reason in order to process the override.
CP: Words are wind. I wonder why I waste so many of them being practical. I bet you tested really high on the parroting part of your interview. Say what.
PBM: What?
CP: Good dog. Now please process the request for my patient; who has no medication; because she never started it; because mail order billed it today but won't send it for weeks; but I need to do all this legwork to lose money; because I care.
PBM: Ok. So the patient is out of medication?
CP: Your parents wouldn't happen to be Cersei and Jamie by any chance?
PBM: Um. I don't think so.
CP: Yes. She is "out" in layman's insurance parlance.
PBM: Ok. I entered the override. Be sure to document on the hard copy the override I provided.
CP: GOT it.

UT: That sounded rough.
CP: We could save so much time if the conversation weren't so robotic. A simple, "Oh her mail-order didn't arrive and you need an override? Here's it is. G'Day!" would be amazing.
UT: As you always say, people today are being trained WHAT to think as opposed to HOW.
CP: You actually listen to me?
UT: You talk a lot. All phreaking day. Must be osmosis.